N421 - Gero Midterm questions with correct answers
older adults safety risks related to medications Correct Answer-•age
related changes and impact on pharmacokinetics and dynamics
•polypharmacy
•chronic conditions
*START LOW AND GO SLOW
pharmacokinetics: absorption and aging Correct Answer-•decreased GI
motility
- possible alteration in absorption
•increased gastric pH due to decreased acid production
- more basic, less stomach acid to break things down
•can be altered by antacids, proton pump inhibitors (PPIs), and
anticholinergic medications
pharmacokinetics: distribution and aging Correct Answer-•decrease in
kidney function
- results in a slower elimination of drugs
- prolongs their exposure in the body, increasing the likelihood of
toxicity
•decrease in body water
- decreased volume increases concentration of water-soluble meds
- increased toxicity
•increase body fat percentage
,- prolonged half life for fat soluble medications
•decrease in serum proteins (albumin)
- increases toxicity of protein bound meds
pharmacokinetics: metabolism and aging Correct Answer-*RELATED
TO DECREASED LIVER FUNCTION WITH AGE*
•declined liver function leads to a slower drug metabolism
- increased half life
•increased toxicity with first pass drugs
- first pass metabolism requires adequate blood flow for drug
metabolism
- decreased blood supply in older adults can result in decreased drug
clearance and increased drug concentration
•P450 (enzyme in liver that breaks down medications) is slowed!
- warfarin (increased risk of bleeding) and phenytoin (accelerates the
metabolism) levels will be higher
•increased risks with increase in number of meds
- drug-drug interactions can interfere with the metabolism or elimination
of medications, leading to increased drug levels and potential toxicity
pharmacokinetics: excretion and aging Correct Answer-•decreased renal
blood flow
- increased toxicity for renal excreted drugs
- NSAIDS decrease renal blood flow and function
•decreased GFR (up to 50% by age 90)
,changes in drug receptor sensitivity (pharmacodynamics) Correct
Answer-•older individuals have more pronounced effects from meds due
to heightened sensitivity
•increased sensitivity (increased response to drugs) leads to stronger
responses to the meds and intensified drug effects
- anticholinergic
- antihistamines
- barbiturates (sedatives)
- benzodiazepines (anti-anxiety medications)
- digitalis (treats heart conditions)
- warfarin (anti-coagulant)
•decreased sensitivity (decreased response to drugs) leads to less effects
- amphetamines (stimulants)
- beta-blockers (treats HBP)
- quinidine (treats irregular heart rhythms)
*depends on individual!
iatrogenic concerns Correct Answer-•side effects caused by treatment or
medication
•can contribute to age related adverse drug events
visual and hearing changes Correct Answer-•interferes with safe
administration
•refer to ophthalmologist/optometrist
, •stop, switch, or reduce the dose of medication affecting vision (e.g.,
anticholinergics)
•consider benefits of cataract surgery
•provide education on depth perception and single vs. multifocal lenses
changes in cognitive function Correct Answer-•increases risk of
anticholinergic effects
•increases CNS adverse effects
cardiac diseases and aging Correct Answer-•impairs cardiac output
- decreased distribution, metabolism, and excretion
- greater susceptibility to cardiac adverse effects
kidney and liver diseases and aging Correct Answer-decreased drug
clearance and metabolism
neurological diseases and aging Correct Answer-•impaired cerebral
blood flow
•greater sensitivity to CNS effects
what is polypharmacy? Correct Answer-•taking 5+ medications
- 30% of adults 65+ take 5 or more
- account for 33% of prescriptions but only 15% of the general
population
•includes supplements, herbals, and OTCs
older adults safety risks related to medications Correct Answer-•age
related changes and impact on pharmacokinetics and dynamics
•polypharmacy
•chronic conditions
*START LOW AND GO SLOW
pharmacokinetics: absorption and aging Correct Answer-•decreased GI
motility
- possible alteration in absorption
•increased gastric pH due to decreased acid production
- more basic, less stomach acid to break things down
•can be altered by antacids, proton pump inhibitors (PPIs), and
anticholinergic medications
pharmacokinetics: distribution and aging Correct Answer-•decrease in
kidney function
- results in a slower elimination of drugs
- prolongs their exposure in the body, increasing the likelihood of
toxicity
•decrease in body water
- decreased volume increases concentration of water-soluble meds
- increased toxicity
•increase body fat percentage
,- prolonged half life for fat soluble medications
•decrease in serum proteins (albumin)
- increases toxicity of protein bound meds
pharmacokinetics: metabolism and aging Correct Answer-*RELATED
TO DECREASED LIVER FUNCTION WITH AGE*
•declined liver function leads to a slower drug metabolism
- increased half life
•increased toxicity with first pass drugs
- first pass metabolism requires adequate blood flow for drug
metabolism
- decreased blood supply in older adults can result in decreased drug
clearance and increased drug concentration
•P450 (enzyme in liver that breaks down medications) is slowed!
- warfarin (increased risk of bleeding) and phenytoin (accelerates the
metabolism) levels will be higher
•increased risks with increase in number of meds
- drug-drug interactions can interfere with the metabolism or elimination
of medications, leading to increased drug levels and potential toxicity
pharmacokinetics: excretion and aging Correct Answer-•decreased renal
blood flow
- increased toxicity for renal excreted drugs
- NSAIDS decrease renal blood flow and function
•decreased GFR (up to 50% by age 90)
,changes in drug receptor sensitivity (pharmacodynamics) Correct
Answer-•older individuals have more pronounced effects from meds due
to heightened sensitivity
•increased sensitivity (increased response to drugs) leads to stronger
responses to the meds and intensified drug effects
- anticholinergic
- antihistamines
- barbiturates (sedatives)
- benzodiazepines (anti-anxiety medications)
- digitalis (treats heart conditions)
- warfarin (anti-coagulant)
•decreased sensitivity (decreased response to drugs) leads to less effects
- amphetamines (stimulants)
- beta-blockers (treats HBP)
- quinidine (treats irregular heart rhythms)
*depends on individual!
iatrogenic concerns Correct Answer-•side effects caused by treatment or
medication
•can contribute to age related adverse drug events
visual and hearing changes Correct Answer-•interferes with safe
administration
•refer to ophthalmologist/optometrist
, •stop, switch, or reduce the dose of medication affecting vision (e.g.,
anticholinergics)
•consider benefits of cataract surgery
•provide education on depth perception and single vs. multifocal lenses
changes in cognitive function Correct Answer-•increases risk of
anticholinergic effects
•increases CNS adverse effects
cardiac diseases and aging Correct Answer-•impairs cardiac output
- decreased distribution, metabolism, and excretion
- greater susceptibility to cardiac adverse effects
kidney and liver diseases and aging Correct Answer-decreased drug
clearance and metabolism
neurological diseases and aging Correct Answer-•impaired cerebral
blood flow
•greater sensitivity to CNS effects
what is polypharmacy? Correct Answer-•taking 5+ medications
- 30% of adults 65+ take 5 or more
- account for 33% of prescriptions but only 15% of the general
population
•includes supplements, herbals, and OTCs
